MEDICARE: WING EYECARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4416	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	LE777753	OTHER		MEDICARE
5	WI9306052	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000122755	OTHER	ANTHEM
2	117687	OTHER	EYEMED
3	4416/T991	OTHER	OHIO LICENSE
6	2200996	OTHER	UHC
7	296623633004	OTHER	MEDICAL MUTUAL

General Provider Information

NPI Number	:	1164610911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WING EYECARE, INC

Provider Business Mailing Address
First Line	:	5303 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3706
Country	:	US
Telephone Number	:	513-921-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3706
Country	:	US
Telephone Number	:	513-921-8040
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	THOMAS F NAGY
Credential	:	O.D.
Telephone Number	:	513-921-8433

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	11/03/2011

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Directions to “WING EYECARE, INC ” Practice Location

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